B-2018-1150 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1150
20612 SUNRISE DR CUPERTINO,CA 95014-2929(359 10 039) ERIC KALLIO
CONTRACTOR
SAN JOSE,CA 95127
OWNER'S NAME: DATE ISSUED:07/10/2018
OWNER'S PHONE: PHONE NO:(408)198-5994
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.4554785
Contractor ERIC KALLIO CONTRACTOR Date 01/3112019 X BLDG ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL HALL BATHROOM-(65 SF);REMODEL MASTER
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM-(70 SF)-TOTAL(135 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
[/Section,3700 of the Labor Code,for the performance of the work for which this
crmt is issued. Sq.IT Floor Area: Valuation:$40000,00
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 359 10039
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERIMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature '
. ^ Date 07/10/2018 Issued by:Jasmine Archbold
Date:07/10/2018
OWNER-BUILDER DECLARATION
I hereby aftlrm that I an,exempt from the C.run—tm's License Law to"one of theRE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a rootis
r. 1,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(See.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to eansetuct the project(Sec.7044,Business&Professions Code). Date:07/10/2018
1 hereby affirm under penalty of perjury one of the following three dechtrations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
s. 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation insurance,as provided for by 1 have read the hazardous materlots requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I stare or handle hazardous
shall not employ in an anew so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
p y any person y ma 1 elr contaminants as dented by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 253534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:�
APPLICANT CEITO PICATION Data:U7110/2018
I certify that I have read this application and state that the above Information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnity and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City In Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHrl'ECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 07/10/2018
Professional